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| Title |
In Patients With Mixed Dentition and First Primary Molar Tooth Loss, Loss of Space Is Not Clinically Significant for the Use of Space Maintainers |
| Clinical Question |
In patients with mixed dentition that have premature loss of primary first molars, is inserting a space maintainer more beneficial for the permanent occlusion compared to not having a space maintainer? |
| Clinical Bottom Line |
In patients with mixed dentition and premature loss of primary first molars, there is a statistically significant loss of space but its clinical significance is controversial. The use of a space maintainer might be questionable in a well-spaced arch with solid intercuspidation. This is supported by a systematic review of controlled studies that evaluated dental arch space problems arising as a result of premature loss of primary maxillary first molar. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 18767508 | Tunison/2007 | 79 studies reviewed; only 3 studies selected | Systematic review of observational studies | | Key results | Three articles were selected based on the methodology criteria. The combination of studies report a loss of 1.5 mm in the mandibular arch and 1.0 mm in the maxillary arch after the early loss of a primary first molar. Although these results are statistically significant, the authors question the clinical significance of the space lost. | |
| Evidence Search |
premature loss primary molar AND dental arch space |
Comments on
The Evidence |
Validity: A systematic review of the available evidence was performed, and out of the 79 articles, 76 were excluded due to lack of information or a low score on their methodology. Three articles met the selection criteria but evidence was insufficient for a meta-analysis. The sample size and methodology of available articles is limited.
Perspective: Based on the systematic review and existing reports further studies with larger sample size and longer follow up period are required.
|
| Applicability |
Careful evaluation of a patient’s individual space needs, compliance and dental development are necessary to determine the need for a space maintainer. After the early extraction of a primary first molar the loss of few millimeters in a well-aligned arch might not be significant but it can be a decision-maker in a patient with an arch length discrepancy that would benefit from every millimeter saved. |
| Specialty/Discipline |
(Orthodontics) (Pediatric Dentistry) |
| Keywords |
Loss of space, premature tooth loss, mixed dentition, tooth migration, space management, space maintainer
|
| ID# |
3244 |
| Date of submission: |
05/03/2017 |
| E-mail |
gonzalezsuar@livemail.uthscsa.edu |
| Author |
Ana M. Gonzalez |
| Co-author(s) |
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| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Maria Jose Cervantes, DDS |
| Faculty mentor/Co-author e-mail |
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Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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